In Praise of Human Organ Sales

Nobel Prize-winning economist Gary S. Becker has long used economic principles to challenge social preconceptions. In 2004, he teamed up with the jurist and legal scholar Richard A. Posner to jointly write a blog. Together, they have spoken out on a wide range of issues including sex and marriage, jobs and the workplace, the environment and disasters, crime and punishment. The blog's commentaries will be published next month by University of Chicago Press in "Uncommon Sense: Economic Insights from Marriage to Terrorism." We asked Becker to write for us on one of his controversial ideas: human organ sales.

GUEST BLOGGER: Gary S. Becker

The average wait for a kidney transplant in the United States is more than four years. The wait for a liver is about two years. Every year, thousands of people die while waiting for such transplants, and while a shorter wait wouldn't save all those lives, it would unquestionably save many.

If the altruism that underpins our current system of organ donation were sufficiently powerful, the supply of organs would be large enough to satisfy demand, and there would be no need for change.

But this is not the case in any country that does a significant number of transplants. While the per capita number of organs donated has grown over time, demand has grown even faster.

In recent years the United States has taken several steps to improve the allocation of available organs among those needing them, such as giving greater priority to those who could benefit the most. But the queue continues to grow nonetheless.

To an economist, it is clear that the major reason for the imbalance between demand and supply of organs is that the United States and practically all other countries forbid the purchase and sale of organs.

If laws were changed to allow the buying and selling of organs, the promise of financial gain would increase the pool of available organs. In a free market, the prices of organs for transplants would settle at the levels that would eliminate the excess demand for each type of organ.

Some critics simply dismiss organ markets as immoral "commodification" of body parts. More thoughtful critics argue that allowing organs to be bought and sold might actually reduce the total number of organs available for transplants because it would cause the number of organs being donated for altruistic reasons to shrink dramatically. That scenario, however, is extremely unlikely since presently only a small fraction of potentially useable organs are available for transplants.

Another set of critics fears that the organ supply would be likely to come mainly from the poor, who would be induced to sell their organs to the rich. It is hard to see any reasons to complain if organs of poor persons were sold with their permission after they died, and the proceeds went as bequests to their parents or children. The complaints would be louder if, for example, mainly poor persons sold one of their kidneys for live kidney transplants, but why would poor donors be better off if this option were taken away from them?

My conclusion is that markets in organs are the best available way to enable persons with defective organs to get transplants much more quickly than under the present system. I do not find compelling the arguments against allowing the sale of organs, especially when weighed against the number of lives that would be saved by the increased supply stimulated by financial incentives.

Comments

Private sales of organs is a wonderful idea. It ensures that organs will go to the richest people and the poor can die like dogs as they deserve. Also, it will allow middlemen to establish and promote "free (organ) markets" and keep the largest share of sale price of the "donor's" organs for themselves. But most importantly, it will ensure an increased availability of organs for the needy rich as a secondary market will develop in assassinations of healthy poor people for organ supply around the world, reducing pressure on the environment and expanding employment opportunities for currently underemployed assassins. Win, win, win.

Posted by: doughty | October 22, 2009 8:37 AM

I don't understand why the post publishes this trash.

Posted by: Peg__Jo | October 22, 2009 9:55 AM

Establishing an organ market will further encourage the erroneous idea that there is such a thing as a "right" to another person's body parts. If individual rights mean anything at all, surely this line must be drawn. That false concept is already inherent in the idea of an "organ shortage"--as if having an endless supply of organs were somehow a natural or normal state of affairs.

Once this concept become firmly established in society, it will inevitably lead to the kinds of abuses we see in India, Egypt and other poor countries, where poor people are tricked or kidnapped and stripped of their organs, sometimes without promised payment and often without their consent.

Like it or not, the limits established by the donor system must remain in place. I suppose I might be frustrated if I needed a kidney, but I hope I would never succumb to the notion that I had a "right" to it.

Posted by: gdmurray1861 | October 22, 2009 10:06 AM

As the death toll from the organ shortage mounts, public opinion will eventually support an organ market. Changes in public policy will then follow.

In the mean time, there is an already-legal way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.

Posted by: daveundis | October 22, 2009 1:00 PM

A lot more could be done to encourage more living donors and to maximize the effectiveness of the kidneys they give, but ultimately neither deceased donation nor barter can fill the need. Compensation for living donors need not leave the poor out of the equation (and most people who need kidneys are, in fact, poor). It would in fact give them a better shot than they have now. The rich can register at multiple transplant centers (think Steve Jobs) and, if necessary, go abroad to the black (or gray) market. See http://www.theatlantic.com/doc/200907u/kidney-donation

Posted by: vp1123 | October 22, 2009 4:20 PM

You have got to be kidding. We can't regulate illegal trade in endangered species. How will be able to regulate legal trade in human body parts?

If you are truly wringing your hands over this, I suggest you send money to organizations that do research on development of artificial organs.